The "Emmet Foley" character is based on real life Christopher Calhoun (b.1934), an inmate of the Florida State Hospital in Chattahoochee, Florida from 1956 to 1962. He moved to Los Angeles after his release and wrote about and became an activist for similarly abused people. In a more modern time he would have been diagnosed with Post-Traumatic Stress Disorder (PTSD) because of his combat in Korea, which is depicted at the beginning of the film.
During the time in which these events were investigated and concluded, the Florida State Governor was The Honorable Leroy Collins; his commission to investigate the abuses at Chattahooche was unwavering in pursuit of the truth, and the commission's efforts at reform brought about wide-ranging changes in Florida's public mental health programs and institutions.
One of three films that stars both Dennis Hopper and Gary Oldman. The others are: Lãng Mạn và Tội Ác (1993) and Basquiat (1996).
During production, Frances McDormand believed that she was filming a comedy.
Abandoned and unused buildings at the South Carolina State Hospital in Columbia stood in for the Florida State Hospital. The whole campus was closed for patient treatment and sold to a re-developer in 2015. The Babcock Building with the dome, prominently seen in the film, was partially destroyed by fire in 2020.